When should I consider referring a patient with hypogonadism to an endocrinologist or urologist?

Consider referring a patient with hypogonadism to an endocrinologist if:

• There is a suspected diagnosis of hypogonadism confirmed by low serum testosterone levels or abnormalities in related hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), or prolactin.
• Testosterone replacement therapy is being considered, as specialist input is needed to manage and monitor treatment.

Consider referring to a urologist if:

• There is a penile structural abnormality or abnormal testicular examination that may require specialist urological assessment.
• The patient is young or has a lifelong history of erectile dysfunction, which may indicate primary erectile dysfunction requiring specialist evaluation.
• There is a history of pelvic, perineal, or genital trauma that could affect sexual function or gonadal health.

These referral considerations are based on the British Society for Sexual Medicine (BSSM) and European Association of Urology (EAU) guidelines, which recommend endocrinology referral for hormonal abnormalities and urology referral for structural or trauma-related issues in men presenting with hypogonadism or erectile dysfunction.

In summary, endocrinology referral is primarily for hormonal diagnosis and management, while urology referral is for anatomical or trauma-related concerns.

NICE CKS